Phys Clinical Cases · general-medicine

Evidence-Based Medicine and Critical Appraisal — DCE Clinical Case

DCE long-case clinical station: comprehensive appraisal, application and shared decision-making for a 75-year-old woman with non-valvular atrial fibrillation, stage 3b chronic kidney disease and a recent mechanical fall, in whom the evidence for stroke-prevention anticoagulation must be integrated with clinical expertise and the patient's values — covering the focused PICO question, the applicability of the pivotal DOAC trial evidence to a patient near the renal exclusion threshold, the computation of the absolute benefit (NNT for stroke) and harm (NNH for major bleeding) for her baseline risk, the GRADE strength and quality of the recommendation, the shared decision-making conversation in plain language, and the documentation and follow-up — structured for FRACP DCE and MRCP PACES.